The Trump administration's anti-fraud sweep of the Affordable Care Act rolls removed about 760,000 people from health plans — and now some of them are being put back. Insurance industry sources told KFF Health News that the Centers for Medicare & Medicaid Services (CMS) has reinstated a small number of enrollees whose coverage should not have been canceled, and that more could follow as people discover they are uninsured only when they try to use their coverage.
The sweep started in June, when CMS selected nearly 1.2 million enrollments carrying four warning signs for fraud: no Social Security number or immigration document number on the application, a broker involved in the sign-up, no monthly premium payment, and no contact with the insurer and no claims filed. Insurers were told to try to reach the enrollees at least two ways and give them 30 days to respond. Those who did not respond were disenrolled, effective August 31 — about 315,000 enrollments covering roughly 760,000 people. Vice President JD Vance announced the halt in September, estimating it would save $2.2 billion.
"This was clearly phantom enrollees." — Brian Blase, Paragon Health Institute
Supporters say the cleanup was long overdue. Brian Blase, whose Paragon Health Institute supplied many of the findings cited by those alleging widespread ACA enrollment fraud, said he believes more than 99% of the cancellations were zero-premium plans that rogue call centers signed people up for without their knowledge — or people who do not exist at all. Anyone wrongly caught up, he said, can be reinstated with a phone call to the marketplace. CMS also runs an expedited review for the improperly disenrolled, and David Merritt of the Blue Cross Blue Shield Association confirmed some BCBS members are already back in.
Critics say legitimate enrollees were caught in the dragnet — people who never opened a letter or answered a call from an unknown number. "There will be legitimate people who don't have a claim or don't respond to an inquiry from an insurer," said Matthew Fiedler of the Brookings Institution. CMS has not said how many cancellations have been reversed: "Currently, there is no additional data to share."
A second phase is already underway, with another 419,000 sign-ups under scrutiny and insurer reports due around mid-to-late November, after the midterm elections. Separately, on Wednesday, Health and Human Services Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz announced subsidies had been ended this year for about 189,000 enrollees who also had Medicare, Medicaid or CHIP coverage, or who were deceased — preventing an estimated $738 million in improper payments this year. "We certainly can't keep paying for people who are deceased," Kennedy said.
For the administration, the story is about protecting taxpayers — making sure every subsidy dollar goes to a real, eligible American. For everyone watching their coverage, the lesson of this sweep is practical: open the mail, answer the call, and prove eligibility before the next round decides.
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